Colon Cancer Flashcards
What are the 6 risk factors for colon cancer?
- Age
- African American race
- Genetic predisposition
- Other GI conditions
- Diet
- Physical inactivity
What is the best type of prevention for colon cancer?
Lifestyle modifications
What are the 3 lifestyle modifications that can be used in colon cancer?
- Diet
- Physical activity
- Limit alcohol consumption
What drug is FDA approved to decrease the number of polyps in patients with familial adenomatosis polyposis?
Celecoxib
What patient population is aspirin reserved in?
Cardiovascular disease prevention
What are 4 screening tests used for colon cancer?
- Endoscopy (colonoscopy)
- Stool DNA test
- Fecal occupant blood test
- Digital rectal exam
What age should patients with average risk get screened?
After age 45
When should a patient get a colonoscopy if they are average risk?
Every 10 years
When should a patient get a flexible sigmoidoscopy if they are average risk?
Every 5 years
When should a patient get a stool DNA test if they are average risk?
Every 1-3 years
What are 5 signs and symptoms of colon cancer?
- Change in bowel habits
- Diarrhea or constipation
- Blood in the stool
- Anorexia
- Abdominal pain/ fullness
- Weight loss
What are the 3 main sites of metastases?
- Brain
- Liver
- Lungs
For diagnosis what is required?
A biopsy
After colon cancer is confirmed, what do patients have to do?
Go through staging scans to determine if disease is already metastatic
For stage I treatment, surgery is followed by what?
Surveillance
True or false: adjuvant therapy can be given to stage I colon cancer patients
False
When can adjuvant chemotherapy be used in stage II?
If patient has poor prognostic factors
What are 2 poor prognostic factors that can be used to determine therapy?
- Larger tumor
- Lymphovascular invasion
Chemotherapy for colon cancer is _____ based
5-FU
How long is a patient on adjuvant therapy for in stage III?
6 months
What is the 1st line chemotherapy regimen for stage III colon cancer?
FOLFOX
What is the oral equivalent to FOLFOX?
CapeOx
What does 5-FU inhibit?
Thymidylate synthase
What drug helps to increase 5-FU activity?
Leucovorin
What are the 5 toxicities that can be caused by 5-FU?
- Myelosuppression
- Hand-foot syndrome
- Diarrhea
- Mucositis
- N/V
How is 5-FU administered?
IV
What drug is the prodrug of 5-FU?
Capecitabine
How is capecitabine administered?
PO
What is the MOA of oxaliplatin?
Cross linking of DNA to cause double-stranded breaks
What is the main toxicity of oxaliplatin?
Neuropathy
What is neuropathy exacerbated by?
Cold temperatures
What is the goal of therapy for stage IV colon cancer?
Palliative care
When can surgery be considered for stage IV colon cancer?
If there is bowel obstruction
What is the best treatment option for stage IV colon cancer?
Chemotherapy
What does FOLFIRI consist of? 3
- 5-FU
- Leucovorin
- Irinotecan
What does irinotecan inhibit?
Topoisomerase I
What is the main toxicity for irinotecan?
Diarrhea
What should you base the choosing of a regimen on for stage IV colon cancer?
Expected tolerability
What are the 3 drugs that are in the FOLFOX regimen?
- 5-FU
- Leucovorin
- Oxaliplatin
What two monoclonal antibody inhibitors can be used in stage IV?
- VEGF inhibitors
- EGFR inhibitors
What does VEGF promote?
Angiogenesis
What 3 things does blocking VEGF cause?
- Inhibition of tumor angiogenesis
- Normalization of tumor vasculature
- Facilitation of chemotherapy delivery to tumor site
Bevacizumab
AVASTIN
What are 5 ADEs of avastin?
- Hypertension
- Proteinuria
- Would healing complications
- Thromboembolic events
- GI perforation
What is avastin only indicated for?
Metastatic colon cancer
What can bevacizumab be used in combination with?
5-FU based chemotherapy
What type of KRAS gene would have a good response to anti-EGFR therapies?
KRAS wild type
What does using an EGFR inhibitor cause? 3
- Inhibits cell growth
- Promotes apoptosis
- Decreases production of growth factors
Cetuximab
ERBITUX
What are 4 ADEs of cetuximab?
- Infusion related reactions
- Acne form rash
- Hypomagnesemia
- Diarrhea
Panitumumab
VECTIBIX
_______ has no role in colon cancer
Radiation
What is the treatment for stage I?
Surgery alone
What is the preferred regimen for stage III?
FOLFOX
What are the 2 EGFR inhibitors?
- Cetuximab
- Panitumumab
Switching for what inhibitors are not recommended?
EGFR